4 months after injury, disproportionate pain and swelling.

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Axial non-contrast

Bones are diffusely demineralized, particularly of the subchondral bone in the midfoot (peri-articular osteopenia). Joint spaces are preserved and congruent. Cortex appears thinned; no acute or stress fracture. No osseous destruction to suggest osteomyelitis.

6 months after injury, persistent pain and skin changes.

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Early images: mildly increased blood flow and blood pool to the left foot, with foci of more markedly increased blood pool in the hindfoot and medial midfoot.

Delayed images: markedly increased osteoblastic activity adjacent to the posterior subtalar joint, adjacent to the articulation between the medial and middle cuneiform bones, and adjacent to the 1st TMTJ. Moderately increased osteoblastic activity adjacent to the 1st MTPJ, and mildly increased periarticular osteoblastic activity elsewhere in the left foot.

Conclusion: Findings are suggestive of reflex sympathetic dystrophy/complex regional pain syndrome of the left foot, with superimposed arthropathy involving the posterior subtalar, intercuneiform and first TMT joints.

Case Discussion

Cedell fractures are rare. Complications included malunion, non-union, AVN, and early OA.